Question 19

What are the most commonly accepted treatment guidelines for this group of patients and could you briefly summarize the general consensus on managing ABECB patients?

Patients defined as being at high risk for treatment failure (as previously defined) comprise the group of patients that drive health care costs higher since clinical failure is associated with repeated visits to the health care professional, more courses of antibiotics, increased hospital admissions and increased mortality. Among these patients, it is prudent to recommend potent antimicrobial therapy (often in conjunction with oral corticosteroids) to prevent these poor outcomes. Accordingly most guidelines recommend either a respiratory fluoroquinolone (gemifloxacin, levofloxacin, moxifloxacin) or a β-lactam/β-lactamase inhibitor such as amoxicillin/clavulanate as first-line therapy as opposed to using older agents and waiting for a clinical failure before using more potent agents (8, 22, 23).